Out health trainers work across London giving sexual health information, answering questions and doing free, rapid HIV tests. This week’s blog is a chance to hear a little bit about what exactly that service entails from one of our health trainers, Terry Riley.

Terry – GMI Health Trainer

What’s your title? I am a health trainer with the GMI Partnership. I work for the outreach arm of the HIV prevention work we do. In other words, I am one of the most visible people working here and I am always working at different places across the city.

What do you do when you’re there? As a health trainer, I am the first point of contact for many gay and bisexual men seeking advice and support. I always bring a range of materials with me (such as condoms, lube, leaflets and booklets) and am on hand to answer any questions that men might have about sexual health. I also do sexual health check questionnaires, which are a chance to give guys information about safer sex, STI’s, HIV and where to get tested. I help guys get a little more support about their sexual health into services across London, such as counselling, mentoring and group support. At some shifts (for example on Saturday afternoons at Ku bar, or on Thursday evenings at Expectations), I do rapid HIV tests (which give the result within a couple of minutes!). My work often involves working with partnership organisations and clinics in order to provide the best service possible for our clients.

OK, so where do you work? The great thing is that we work in a whole range of venues from bars and clubs in central London (like Soho) and further afield too, like Clapham, Vauxhall and Shoreditch. We also work in sex on premises locations such as saunas, like Chariots and in clinics like 56 Dean St and CLASH (Mortimer clinic). We are always at the most important ‘gay events’ in London, such as the London Pride and other festivals. So it’s a real mixture of places!

What’s the most interesting thing about the job? My work is really about connecting with people, which I love! You never know what you are going to talk about on any given night. Everyone we speak to is different and has individualistic needs. For example, one outreach shift you could be talking about drug or alcohol use with an older gay man and the next one you might be answering questions about coming out and relationships with someone who is young and curious. Next you could be working with someone married who doesn’t consider themselves to be gay or bisexual and answering questions about where to get a HIV test or how STI transmission occurs. It’s never boring and always interesting! If I go home at the end of a shift and feel that I have connected someone with the right information or support that they need, then I feel my work has been worthwhile!

What are some common questions you are asked? I am really asked everything and anything about sexual health to be honest. Some questions I am frequently asked are: Where can I get a HIV test? Have I put myself at risk? How do the drugs I’m taking impact my HIV/STI risk? How can I keep myself safe sexually? How can I bring up using a condom with other guys?In three words how would you describe the health trainer outreach programme? Friendly, non-judgemental and supportive!

If you would like more information on the health trainer programme please contact us at healthtrainer@gmipartnership.org.uk or have a look at our website here. For information on where our health trainers will be at different times over the next month or so please take a look at the calendar here.

Around the world there are people who claim to be able to ‘fix’ homosexuality by making gay people straight. In the West curing homosexuality is most commonly carried out by private therapists and churches and takes the position that same sex attraction is immoral and sinful. With the growth of the Evangelical church in the UK (especially in London) and the US in recent years there is increasing concern about the methods and consequences of those who claim to be able to cure homosexuality.

Just last year four gay men sued a Jersey City group for fraud over its programme which made them strip naked and hit effigies of their mothers with baseball bats and similarly questionable approaches have been used in programmes across the States (see here) . A former US Pentecostal interviewed in the Guardian criticsed his former Church for using counserllors., amongst other techniques, to ‘enable’ the faithful overcome their homosexual feelings. He argued that such approaches did not work and left him feeling bad about himself and the feelings he was having. He also highlighted a darker side of those carrying out gay ‘conversion’ therapies ‘arguing that they give moral authority to bullies’, implying that often the programmes are carried about by those with dubious motives and often with the awareness that they do not achieve so-called conversion. For reasons such as these this week the US Governer of the state of New Jersey, Chris Christie, signed a bill to bar therapists who claim to be able to cure teenagers’ sexuality and this follows recent legislation passed recently in California (see here) . After considering evidence from the American Psychological Association (APA) he decided that there were ‘critical health risks’ for minors involved in such programmes.

The key problem with gay conversion is that it can have enduring damaging effects on the lives of those that have taken part. They often cause confusion, shame and sometimes even depression or suicidal feelings. They create a belief in the gay participant that their behaviour is wrong. Add this to the fact that feelings of same sex attraction rarely, if ever, disappear after doing such programmes can leave the individual with psychological issues related to low self-esteem and guilt. For these reasons gay conversion therapy is widely criticised and controversial by health professionals and gay rights groups, amongst others. Thankfully, though there are now signs of change even within the groups that have carried out conversion programmes. There is recognition amongst some that they are unlikely to work and can cause damage to those taking part. For example, Alan Chambers, the president of Exodus, the global gay cure church, who recently shot to fame after appearing on an Oprah programme about ‘pray away the gay’ approaches, has admitted that 99.9% people cannot be cured through gay conversion programmes and recently publically apologised for the harm that these programmes have caused (also see here).

Thankfully gay conversion programmes are much less prevalent in the UK than in the States (although not non-existent, see recent Telegraph article), but the issues related to shame and guilt over ones sexual orientation are encountered frequently by those working in sexual health. These feelings might be related to family, cultural or religious background and can form a strong driver in sexual behaviour and risk taking. These are key factors that are explored in our counselling, mentoring and healthtrainer programmes, which work with gay and bisexual men in a non-judgemental way to focus on the reasons for increased sexual risk and put together appropriate, tailored approaches aimed at reducing risk taking. For more information see our website or e-mail info@gmiparntership.org.uk.

The views above are those of the author and do not necessarily represent those of the GMI Partnership.

The situation for LGBT people living in Russia seems to have gone from bad to worse in the last few weeks. Putin’s government has drafted anti-LGBT legislation that makes talking about LGBT issues in public illegal (deemed ‘propaganda’) apparently because doing so promotes ‘non-traditional relationships’ which is dangerous to minors. As a result, a few days ago a Canadian childrens’ author received threats from Russia branding him a paedophile because he wrote a children’s book about a prince who falls in love with another boy. Recent law changes follow previous homophobic amendments to adoption laws which have prevented the adoption of Russian children by same-sex foreign couples.

At the same time (and possibly as a consequence of changes in legislation), there have been a spate of increasingly brutal attacks against the LGBT community living in Russia which are now all over the international press. Videos have shown young LGBT men being humiliated, beaten and tortured. In some of the photos being circulated online young men are being forced to drink urine or are having it thrown over them by a nationalist group calling themselves Kamensk-Uralsky. They state that their aim is to cure the young men of their homosexuality. There have also been reports of LGBT youths that have been shot after being lured online with the promise of romantic liasons and yesterday the Pink News claimed that Russian social media sites are posting videos of a young man who was kidnapped, tortured and killed. The laws aren’t affecting only Russian’s living in the country either, last week a visiting Dutch researcher was interrogated by police for hours before being fined simply for conducting research in the experience of LGBT people in Murmansk, in the north of the country. His crime – ‘gay propaganda’.

Homophobia and sexual risk

Although the reasons for the sudden rash of homophobic legislation in Russia seem unclear, they are already having negative consequences on the lives of young gays, lesbians and trans people living there. Many are scared to leave their houses and others have stopped using online sites and apps for fear of the consequences. Whilst levels of homophobia in the UK are, thankfully, not comparable to those currently experienced in Russia, discrimination is still part of day-to-day life for many of those who identify as LGBT. A recent survey published by the BBC showed that 5-7% of those questioned said that they thought homophonic assault and harassment was ‘very widespread’. Homophobia still has an impact on the way many LGBT people live their lives in the UK today and even has an impact on sexual behaviour. Whilst they may seem like completely separate issues, actually there is a link between homophobia and risks taken sexually. Bullying can cause a low sense of self esteem, which, in turn, can cause individuals to have a low sense of self worth and take risks, such as through having unprotected sex or mixing hardcore drugs and sex. The importance of considering the relationship between homophobia and sexual behaviour is a key part of the programmes offered through the GMI Partnership. The counselling and mentoring programmes explore the wider, emotional factors that influence sexual decision making and notions of risk including discrimination, identity, relationships and self-esteem. Our one-to-one programmes allow such connections to be discussed in a safe and confidential environment with trained staff and volunteers who are non-judgmental and here to support gay and bisexual men have the safer sex they want to be having, even if they don’t know what changes to make to achieve this. For more information on the free programmes the GMI Partnership offers please contact tony@metrocentreonline.org

What are your views of the current situation in Russia? Have you ever thought about the links between homophobia and sexual behaviour?

The views in the article are those of the author and do not necessarily represent those of the GMI Partnership.

In the last decade huge advances have been made in biomedical approaches to HIV prevention, particularly in terms of TAP and PrEP. TAP, or treatment as prevention, means giving ART (anti-retroviral treatment) to men who are HIV positive to reduce onward HIV transmission, while PrEP means giving medication to men who are HIV negative to reduce the chance that they become HIV positive (seroconverting). At the turn of the century these methods of HIV prevention did not even exist and now trials are being conducted to determine whether they can be used on large scales around the world. In London the Proud study is currently recruiting men who have had unprotected sex to take part in PrEP trials (For more information and to participate in the study click here ).

But what trials into biomedical HIV prevention show and what consequences do they have for HIV prevention work in the future? Well, by and large trial results are promising with most trials showing a reduction in HIV transmission. However, this varies depending on the study, with some trials showing exceptionally high reduced transmission rates, such as the HIV Prevention Trial Network (96% reduction), whereas others show much more modest rates of reduction (see this study and this overview, for example) and some have had to be stopped altogether as they were inconclusive. Studies have shown that varying efficacy is likely to be the result of various factors such as the type of sexual behaviour, varying rates of site effectiveness (e.g. after gel application) and adherence to medication. Consequently, while biomedical prevention is going to play a much bigger role in HIV prevention it would seem that alone it cannot prevent HIV transmission and would be best looked at as part of a wider approach incorporating current successful behavioural approaches. In particular, research suggests that behavioural approaches focused on one-to-one, participant centred, long term support must be carried out in conjunction with TAP or PrEP to bring about significant reductions in HIV transmission. Related to this, studies also show the importance of behavioural approaches focused on medication and adherence to medication. This might include factors such as barriers to taking medication, feelings about medication and specific factors that might influence medication adherence (which studies have shown have a large . One example could be the party drug scene popular amongst gay and bisexual men in the UK (and elsewhere), which could have a huge impact on whether treatment is taken as required for PrEP/TAP and attitudes towards treatment, as well as sexual behaviour. Failure to include such elements means even treatment approaches successful in other settings might be far less successful when applied to MSM in Western cities, for example.

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So, do biomedical approaches to HIV prevention represent a breakthrough? Undoubtedly – huge changes have occurred since the start of the 21st century and knowledge in the area had increased exponentially. Will they change the way HIV prevention looks in the years to come? Absolutely – indeed HIV prevention approaches are already changing as a result. Do they present all the answers for HIV prevention? Definitely not – the consensus amongst researchers and providers is that a combined approach to HIV prevention is more effective than either a biomedical or behavioural approach alone. Thus, while biomedical approaches provide hope, they do not, single handedly, represent the key to reducing HIV transmission. This was reiterated this week when Roger Peabody of Aidsmap argued that ideas to the contrary must be challenged as they ‘rely on utopian assumptions, such as 100% of people getting tested and 100% of diagnosed people taking antiretroviral treatment’ (see here). In reality, a combined approach to HIV prevention which acknowledges the importance of human behaviour in HIV prevention as well as focusing on medication can ensure that the breakthroughs that have been made in recent years are translated through to reductions in HIV transmission.

What do you think? Maybe you disagree and feel that TAP and PrEP can shape future HIV prevention alone. We want to hear from you Leave any comments below. The views above are those of the author and do not necessarily represent those of the GMI Partnership.

The GMI Partnership provdes free sexual health counselling, mentoring and one-to-one support for gay and bisexual men living, working or socialising in London. For more information on our services please contact tony@metrocentreonline.org